University Hospital Southampton NHS Foundation Trust

SDE_WXS_PROJ_123

In Neurosciences ICU (NICU), precise blood pressure control is strongly recommended in patients with brain haemorrhage (bleeding) and inflammation due to dangerously high blood pressure. It is postulated that rapid control is beneficial to patient survival and long-term recovery, but this has not been consistently demonstrated. There is some evidence, however, that stability in blood pressure control is more important. Our project aims to compare two commonly used medications – labetalol and nicardipine – to understand which provides better blood pressure management for our patients. On NICU, we currently use labetalol for rapid control of blood pressure but have, at times, found it to be ineffective and unpredictable. We are transitioning to nicardipine, a newer medication which has more predictable effects. A before-and-after comparison will help us to understand which medication works better for our patients. Our patients are continuously monitored, and this is linked to our electronic record, providing high-quality data. With blood pressure readings stored electronically every minute, analysing the data on many patients over multiple days of therapy the volume of data cannot be easily studied without data science approaches. We will use these to rapidly extract, clean and analyse the highly granular continuous monitoring data giving us a clearer understanding of how each drug affects blood pressure control. We will also explore if modern techniques such as signal processing and ‘dynamic time warping’ can further enhance this understanding. By integrating other data from the electronic health record (EHR) we can also develop a broader awareness of the patient experience and outcome as well as possible implications on the organisation, such as cost and staff time. Using this data we will focus on three key areas. Firstly, we will compare the effectiveness of each medication for blood pressure control exploring whether target pressures were achieved; the speed at which they were achieved and, how stable this effect was. Secondly, we will compare how each medication affects important patient outcomes, including: length of NICU stay; likelihood of death-in- hospital; change in size of the brain bleed (if applicable) and potential medication-related side effects and complications. We will also try and find other data sources for outcome measures such as patient function and longer-term outcomes. Finally, we will explore the impact on the hospital and its staff. We will use the accurate medication data from the EHR to calculate costs and also consider how staff may be affected by considering differences in how the drug is used, like how often the syringe needs to be changed or how frequently the rate is being adjusted.

The project brings together clinical expertise and data science, to answer whether Nicardipine is the best agent for acute blood pressure control on NICU and how it is different from our current agent, Labetalol. We aim to provide evidence-based guidance for our own clinical practice and identify further areas of study.

31/10/2025

TRE